The impact of menopause on cardiovascular disease risk and nutritional strategies to enhance health
potential of women as they age.

Menopause involves changes within the female physiology that appear to exacerbate the risks of ill health that are associated with normal aging (1). There has been a growing concern and new research into these mechanisms of hormonal change and how these might be exerting a negative influence on blood lipid concentrations and glucose metabolism (2,3) increasing the risk of cardiovascular disease (CVD) in women (1,4,5)

Key Points:

• Menopausal changes appear to exacerbate multiple health risks in older women
• CVD is the largest cause of mortality in women age 50-65 (2)
• Compounds found in whole foods show promising results
• Specific nutrition that supports a health enhancing lifestyle strategy for women
• Risks and outcomes may vary depending on genetics and other personal factors

Discussion:

The health concerns, symptoms and increased risk factors associate with menopause and post-menopause vary from woman to woman and are linked to genetics, lifestyle (epigenetics) or other individual factors. It is clear that menopause is characterised by a decline in estrogen and progesterone production, along with elevated follicle stimulating hormone (FSH) and/or luteinising hormone (LH). This hormonal imbalance has a knock on effect on other hormones, organs and systems within the body (6), but the wider impact of these changes is still not fully understood or scientifically documented. For some time medicine focused on the drop in estrogen/progesterone as being the main issue, however, there is some emerging evidence that elevated levels of FSH may be a contributing factor for hypercholesterolemia and CVD risk in women (7,8),
but more research is needed.

CVD is a collection of disorders of the veins and arteries, particularly of risk to heart, brain and peripheral tissue. The most common of these disorders is atherosclerosis, which is a type of plaque that is believed to form as a result of lesions or damage in the delicate lining of the arteries that the body attempts to fix and repair through an anti-inflammatory immune  response. Cholesterol lipoproteins such as LDL are involved in this ‘fix and repair’ response. There are a number of potential causes and multiple factors involved in the progression of atherosclerosis. The risk factors include hyperglycemia, advanced glycation end (AGE) products, type 2 diabetes, oxidised lipids, oxidised LDL/cholesterol, high blood pressure, oxidative stress and inflammation (8). Therefore, lifestyle strategies that help to mediate these risk factors, normalise blood glucose levels and support the immune, repair and anti-oxidant functions within the body would be useful approaches to help reduce CVD risk in women as they age.

Also important to consider is the growing awareness that metabolic, hormonal and immune disruptions may be triggered or perpetuated through multiple pathways including emotional, physical or mental distress, life changes, sedentary lifestyle and inflammatory substances found in processed foods, beauty products, household products, plastics and other environmental toxin exposure. Some potentially damaging inflammatory factors that we can control include ‘trans-fats’ from processed foods, excess ‘sugar’, excessive ‘stress’ and ‘chemicals’ used around the house or on the skin.

The protective role of phytochemicals, polyphenols and phytoestrogens:

1. What are Phytochemicals, Polyphenols and Phytoestrogens?

Phytochemicals are naturally occurring compounds usually found in plant foods, including herbs, spices, legumes, fruits and vegetables (9). Polyphenols are a group of phytochemicals produced in plants and include flavonoids, phenolic acids and lignans. Flavonoids include compounds such as quercetin, flavones, anthocyanins and isoflavones, found in a spectrum of colourful plant foods. Lignans are components of plant cell walls in many natural whole foods. People who consume a polyphenol rich diet tend to have a lower risk of heart attack in both case-control and cohort studies (10). Phytoestrogens are phytochemicals that have similarities to estrogen/estradiol.

2. Protective legumes

Beans and lentils contain a range of beneficial proteins, flavonoids and phenolic acids exhibiting health enhancing properties such as antioxidant, estrogenic and liver support. Mung beans have gained particular interest recently for their potential to improve hyperlipidemia and liver toxicity (11). All forms of mung bean appear to have potential benefits on antioxidant levels, cholesterol metabolism/excretion, triglyceride levels and liver function, with fermented sources providing best results (12,13).

Soy beans are the most intensively researched and have been shown to have some vasorelaxant and hypertensive actions on the cardiovascular system, plus a positive impact on blood lipids and atherosclerosis indicators (6,8). They seem to help reduce LDL oxidative damage, but not as well as the antioxidant compounds in colourful fruit and vegetables (14). However, ‘isolated’ soy isoflavanoids don’t seem to reduce cholesterol or LDL levels (15).

Chickpeas are another useful legume that deserves more attention and research. The chickpea isoflavones have shown potential at normalising elevated blood levels of FSH and LH (16). Isoflavones are also present in berries, wine, grains and nuts, but are most abundant in legumes, flax seeds and red clover (12). It is clear that a variety of beans provide a range of health benefits to menopausal women and may help to reduce atherosclerosis risk factors when combined with other supporting strategies. When prepared correctly and consumed as part of a sensible balanced eating plan by people who can tolerate legumes, there is little chance of toxic effects. However, for the best health benefits, look for non-GMO or organic
sources. Legumes are available in many forms such as dried, canned, flours, pastas, protein powders, sprouts and ferments. To maximise nutrient availability and health benefits experiment with simple sprouting and/or fermenting chickpeas or mung beans at home.

3. Protective seeds and lignans

Flaxseeds (also known as linseeds) are the richest plant source of lignans (10) and may be as effective as soy or chickpeas in their positive effects on ‘estrogen’ metabolism in post-menopausal women (17). Milled flaxseeds show potential for lowering circulating LDL and total cholesterol (18), and the latest cell research shows that flax lignans might enter lipids to provide antioxidant effects (19). The best results are gained through ‘milling’ or ‘crushing’ whole seeds and consuming within 48 hours or freezing to preserve (20,21).

Flaxseed oil or lignan isolates have no observed benefit to cardiovascular health (22). It is probable that the high fiber content of milled flaxseed is responsible for its cholesterol–lowering actions by hindering reabsorption from the intestines (18).
Lignans are also found in many fiber-rich foods including other seeds, berries, grains, nuts and fruits.

4. Specific antioxidants and anti-inflammatory compounds

Anthocyanins occur abundantly in nature as the dark purple, blue or red colouring in berries, flowers, seeds, roots and leaves. Anthocyanins are powerful antioxidants that have potential to moderate inflammatory compounds relating to atherosclerosis (23) and also favourably influence serum lipid levels and glycemic control (24). Anthocyanins are linked to improvements in total cholesterol/HDL ratio, oxidative damage markers, triglyceride and blood glucose levels (25) and with no negative effects
reported. Blackcurrants, high in anthocyanins, seem to improve oxidative stress, blood pressure, blood flow and exercise tolerance (26) and therefore may be useful in conjunction with a daily exercise regimen to reduce CVD risk.

Quercetin is a typical flavonol found in a wide range of plant foods and has been found to favourably influence LDL concentration (27), LDL oxidation levels, cholesterol metabolism (28) and progression of atherosclerosis (29). Quercetin is found most abundantly in onions, and in much smaller amounts in blackcurrants, green tea and other fruits and vegetables (27,29).

Curcumin occurs as the orange colour in turmeric and appears to have a broad protective action (30). It has shown promise for improving lipid metabolism dysfunction, reducing oxidative damage (31), protecting body tissue, tempering inflammatory responses and reducing fat storage (32) during periods of hormonal change. Curcumin also significantly enhances blood glucose control by reducing insulin resistance, serum insulin levels and serum triglyceride levels (32). Turmeric spice may be accompanied by black pepper and healthy oils to improve bioavailability (33).

CoQ10 is naturally produced in the cells of the body and is carried within LDL and HDL cholesterol molecules in the blood where it helps prevent oxidation (34). Therefore, it is wise to optimise the lipid ratio of CoQ10 in the body. CoQ10 is present in fish and organ meats, and in small amounts in muscle meat and a variety of green vegetables. There is not enough evidence that supplementation on its own can reduce LDL concentrations or minimise risk of cardiovascular events (35).

Conclusion

A holistic healthy lifestyle strategy mindful of nutrition, movement, sleep, toxin and stress management would help to minimise CVD disease risk and maximise health-span for women as they age. Carbohydrates and starchy foods are best viewed as ‘activity dependent’, because overconsumption may exacerbate inflammation and metabolic chaos that drives disease risk.

I recommend a wholefood nutritional approach with appropriate protein and healthy fats throughout the day to support blood glucose management and energy levels. Eat a rainbow of plant foods daily to naturally increase the antioxidant and anti-inflammatory compounds available for healing and repair activities within the body. Include a variety of colourful berries, vegetables, herbs, spices, seeds, flaxseeds and legumes (depending on tolerance).

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